Provider Demographics
NPI:1366748949
Name:WIERSMA, ROBERT MOUW
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MOUW
Last Name:WIERSMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1561
Mailing Address - Country:US
Mailing Address - Phone:712-324-8385
Mailing Address - Fax:
Practice Address - Street 1:1022 3RD AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1561
Practice Address - Country:US
Practice Address - Phone:712-324-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health